Radiology departments perform imaging procedures every day. Each of these procedures requires a set of precise specifications of their use called a protocol. An example of how a particular protocol is selected for a particular patient is described next in connection with typical workflow for a patient who is to be imaged via a computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), or other medical imaging scan.
A prescribed order from a referring physician for an imaging examination is received by a radiology department, imaging center or the like. The order typically describes the general type of examination (CT, MRI, PET, US, etc.) and the anatomy to be scanned. Additionally, the order will include the clinical indications that resulted in the order. The clinical indications usually include signs, symptoms, and clinical history, and may also include hypotheses of the underlying disease or condition or mention “rule-out,” which also suggests potential conditions that should be investigated in particular.
A radiologist reviews the order and assigns an imaging protocol for the patient based on the specific clinical indications. This process is referred to herein as “protocoling”. The imaging protocol defines the settings used on the imaging equipment to acquire the images, and directs the imaging technologist who operates the scanner in how to perform the examination. The selection of the protocol generally occurs before the patient is scanned, typically hours to days before the patient arrives for the examination.
By way of further example, a patient's imaging order may include the indication “hearing loss in left ear,” with the note to perform an “MRI of the head.” Within this general examination type, there are many options of clinical imaging protocols that are used specifically by the imaging centre or radiology department. Examples that are under the general category “MRI of the head” may include “brain tumor,” “multiple sclerosis,” “angiography,” “MR without contrast,” “internal auditory canal,” “eye-orbit,” to name a few. A radiologist reading this order may decide that the order is best fulfilled by using the “internal auditory canal” protocol.
The selection of the most adequate imaging protocol for a given patient is based upon the available information from the patient clinical record. The record includes the current imaging order from a referring physician, which contains the “clinical indications” that caused the patient to be referred to imaging. Unfortunately, in some instances, it is possible that missing pieces of information (such as other clinical indications) in the order could lead to a sub-optimal selection of the best imaging protocol. Furthermore, in some cases, clinical information, in addition to the information in the order, that would facilitate protocoling is absent from the patient record.